1例丙硫氧嘧啶致胰岛素自身免疫综合征患者的诊疗分析  

Analysis of Diagnosis and Treatment of One Patient with Insulin Autoimmune Syndrome Induced by Propylthiouracil

作　　者：郑应麟 黎小燕[1] ZHENG Ying-lin;LI Xiao-yan(Department of Endocrinology,Ganzhou People's Hospital,Ganzhou Jiangxi 341000,China)

机构地区：[1]赣州市人民医院内分泌科,江西赣州341000

出　　处：《抗感染药学》2024年第12期1233-1236,共4页Anti-infection Pharmacy

摘　　要：目的:分析1例丙硫氧嘧啶致胰岛素自身免疫综合征(insulin autoimmune syndrome,IAS)患者的诊疗过程,为临床IAS的诊断和治疗提供参考。方法和结果:该患者因甲状腺功能亢进、低血糖来院治疗;入院后,完善检查发现,患者胰岛素抗体呈阳性,且胰岛素水平>1000μIU/mL,故考虑可能为IAS,遂停用丙硫氧嘧啶;2 d后,进行口服葡萄糖耐量试验和C肽、胰岛素检查,发现低血糖时胰岛素、C肽水平升高,且胰岛素、C肽升高幅度明显不匹配,遂明确IAS诊断,加之低血糖进出现在服用丙硫氧嘧啶之后而之前并没有,故考虑IAS为丙硫氧嘧啶所致;于是,临床嘱继续停用丙硫氧嘧啶,并予口服醋酸泼尼松,同时调整饮食结构且少食多餐;1周后,患者未再出现低血糖,并且1年的随访显示,患者血糖和胰岛素抗体水平均正常,胰岛素水平除1次稍有偏高外也均正常。结论:IAS作为一种较为罕见的疾病,其诊断应综合考虑血糖、胰岛素、C肽、胰岛素抗体等指标情况,以及药物的诱发因素,在准确诊断的基础上开展针对性治疗,方可使患者获得有效且安全的治疗。Objective:To analyze the diagnosis and treatment process of a patient with insulin autoimmune syndrome(IAS)induced by propylthiouracil(PTU),and provide reference for the clinical diagnosis and treatment of IAS.Methods and Results:The patient was admitted for treatment due to hyperthyroidism and hypoglycemia.Upon further examination,the patient was tested positive for insulin antibody,with an insulin level greater than 1000μIU/mL.IAS was suspected,and PTU was discontinued.Two days later,oral glucose tolerance test and C-peptide and insulin tests were conducted.It was found that during hypoglycemia,both insulin and C-peptide levels were elevated,and the increase in insulin and C-peptide levels was significantly mismatched,confirming the diagnosis of IAS.Given that hypoglycemic episodes occurred after PTU administration and not before,it was considered that IAS was induced by PTU.The patient was instructed to continue discontinuing PTU and was prescribed oral prednisone acetate,along with adjustment of the diet to smaller,more frequent meals.One week later,the patient no longer experienced hypoglycemia,and follow-up after one year showed that blood glucose and insulin antibody levels were normal,with insulin levels only slightly elevated on one occasion.Conclusion:IAS is a rare disease,indicators such as blood glucose,insulin,C-peptide,insulin antibody,and drug induced factors should be comprehensively considered for its diagnosis.Targeted treatment based on accurate diagnosis is essential for effective and safe treatment of patients.

关 键 词：丙硫氧嘧啶 胰岛素自身免疫综合征 低血糖 诊断 治疗 合理用药 

分 类 号：R969.3[医药卫生—药理学]